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NPI Code Detail

MEDICARE: DANIEL CERQUERA ATC

MEDICARE:   DANIEL  CERQUERA  ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer002562NY

General Provider Information

NPI Number : 1215440524
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIEL CERQUERA ATC
Provider Business Mailing Address
First Line : 8-07 WHITESTONE EXPRESSWAY
Second Line :
City : WHITESTONE
State : NY
Zip : 11358
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5454 N HAVERHILL RD
Second Line :
City : WEST PALM BEACH
State : FL
Zip : 33407-3006
Country : US
Telephone Number : 718-791-2317
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2017
Last Update Date : 11/08/2017

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Directions to “ DANIEL CERQUERA ATC” Practice Location

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